Ebola – undoing HIV progress in Sierra Leone

1 December 2014 - Today, thousands of people in Sierra Leone are living with an incurable virus characterised by a sense of fear, stigma, discrimination and misinformation: HIV.

Christian Aid has distributed food aid to vulnerable people in quarantine, including people living with HIV

Some 57,000 people in Sierra Leone live with HIV. In recent years the country has made significant strides in reducing the spread of the virus and associated stigma. Prevalence rates are relatively low among the general population, and have been stable since 2008, while prevalence among pregnant women has also been on the decline.

That was before Ebola hit Sierra Leone. Today, on World AIDS Day, as the international community works towards achieving 'zero new HIV infections, zero discrimination, zero AIDS-related deaths', organisations in Sierra Leone are warning that the country's HIV gains are being reversed by the Ebola crisis.

While the rate of infection in Liberia and Guinea appears to be slowing, the Ebola virus continues to spread rapidly in Sierra Leone. With the disintegration of the country's fragile healthcare system, the outbreak is having a severe impact on access to HIV treatment, counselling, nutritional support and testing.

The World Health Organisation has warned that people living with HIV are ‘increasingly vulnerable’ as a result of the health crisis. Sierra Leone's National HIV/AIDS Secretariat says the outbreak has 'greatly threatened' the prevention and control of HIV. And according to UNAIDS, community and faith-based HIV services have been 'seriously disrupted'.

These warnings are being echoed by Christian Aid partner NETHIPS (The Network of HIV Positives), which provides care and support for people living with HIV in Sierra Leone. Almost all NETHIPS regular activities – including counselling, support groups, stigma-reduction training and treatment adherence sessions – are currently at a near-standstill.

'People living with HIV live in constant fear. They are suffering in silence,' explains NETHIPS Executive Director Mr Idrissa Songo, who says Ebola has had ‘untold negative effects’ on the work of NETHIPS and other HIV service providers nationwide.

'People living with HIV consider themselves highly vulnerable to Ebola because of their already compromised immune system, so they consider health service providers as high risk – hence the reluctance of some to access HIV services, or even go to hospitals. They are afraid to use health services for fear of being labelled as Ebola patients, because the side effects of some anti-retroviral drugs – such as nausea and vomiting – are similar to the early signs of the Ebola virus.’

NETHIPS is concerned that people living with HIV are increasingly being mistaken for Ebola patients. Mr Songo explains: ‘High fever is a common symptom for HIV and is the determining factor for a referral for Ebola testing. Since communities are being asked to report sick people to the authorities, some people living with HIV are being forced to prematurely/unwillingly disclose their HIV status to avoid being carted away as Ebola patients.

'This has led to much embarrassment for people living with HIV. Imagine having to share this information with a community that sees HIV as a consequence of promiscuity, immorality and a curse from God. The issue of premature disclosure has lots of social implications. It could lead to shame, separation, divorce, isolation or even death.'

Perhaps of greater concern is the way the Ebola outbreak is severely restricting access to life-prolonging anti-retroviral (ARV) treatment. Prior to the outbreak, over 130 facilities across Sierra Leone provided ARVs, which controls the virus, enabling people to live healthy lives and reduce the risk of transmission to others. Before the Ebola virus hit Sierra Leone, 9,000 people were receiving ARVs.

HIV service providers in Sierra Leone have now warned of a serious decline in take up of treatment: UNAIDS assessments have revealed that several ARV sites are no longer up and running in Sierra Leone. Since continuity of healthcare is critical, any abrupt halt in treatment could cause sickness and increase both the risk of resistance to the medication and the likelihood of passing on the virus, including for pregnant or breastfeeding women.

'ARV adherence has become a very big challenge,' Idrissa Songo says. 'There is a serious impact on access to treatment, particularly for people in quarantined households. An increase in treatment default is likely to reverse the gains in the response to HIV in Sierra Leone. There is a risk that more people living with HIV could die from preventable/treatable illnesses.'

Since good nutrition is necessary for ensuring the effectiveness of ARV treatment, NETHIPS has also voiced concern at the risk of malnutrition for homes under quarantine. The organisation has worked with Christian Aid to distribute emergency food supplies to around 2,100 vulnerable individuals, including people living with HIV. Christian Aid will be distributing food aid to a further 3,000 people in quarantine over the next few weeks.

At the same time, NETHIPS will continue using its networks to trace people who have discontinued their treatment, monitor ARV supplies and use its counsellors to find new ways to support and encourage people to access health services. Nevertheless, the organisation fears what the lasting impact of Ebola could have on Sierra Leone's HIV work.

'If the Ebola epidemic continues unabated, the probability for us as a country to achieve the Millennium Development Goal 6 by 2015 will be very slim,' says Mr Songo. 'If urgent action is not taken towards a HIV-sensitive Ebola response, the outbreak will continue to have adverse effects on the HIV programme, and what is left to show as gains in the HIV response will be low.'

Notes to editors:

1. Christian Aid works in some of the world's poorest communities in around 50 countries at any one time. We act where there is great need, regardless of religion, helping people to live a full life, free from poverty. We provide urgent, practical and effective assistance in tackling the root causes of poverty as well as its effects.

2. Christian Aid’s core belief is that the world can and must be changed so that poverty is ended: this is what we stand for. Everything we do is about ending poverty and injustice: swiftly, effectively, sustainably. Our strategy document Partnership for Change explains how we set about this task.

3. Christian Aid is a member of the ACT Alliance, a global coalition of more than 130 churches and church-related organisations that work together in humanitarian assistance, advocacy and development. Further details at http://actalliance.org